Provider Demographics
NPI:1104902162
Name:VELAZQUEZ, CARMEN
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 AVE SAN PATRICIO
Mailing Address - Street 2:MARAMAR PLAZA SUITE 1150
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-2645
Mailing Address - Country:US
Mailing Address - Phone:787-793-2623
Mailing Address - Fax:787-793-2700
Practice Address - Street 1:101 AVE SAN PATRICIO
Practice Address - Street 2:MARAMAR PLAZA SUITE 1150
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-2645
Practice Address - Country:US
Practice Address - Phone:787-793-2623
Practice Address - Fax:787-793-2700
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13910208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21005Medicare ID - Type UnspecifiedPROVIDER'S NUMBER